Alexandria Soccer Association
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Email *
Season(s) You Will or Plan to Participate In *
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First Name *
Last Name *
DOB (MM/DD/YY) *
Zip Code *
Please put the name of the team you will be participating with. (put Free Agent team if you have signed up as an individual/free agent player). *
 Adult League Waiver
Consent and Commitment: I agree to abide by the applicable rules and policies of ASA as they may change from time to time, and those of the organizations that oversee or facilitate ASA’s soccer programs, such as the City of Alexandria Dept. of Parks & Recreation (“Affiliated Organizations”).

Waiver and Release of Claims: I acknowledge that soccer is a rigorous physical sport that involves player contact. I understand that ASA is a non-profit, charitable organization, and many adults performing its work are volunteers. On behalf of myself, I release ASA, its employees, coaches, officers, directors, agents and volunteers, and those of any Affiliated Organizations, from, and I waive, all liability, claims, suits and causes of action for all losses, damages or personal injury that arise from or are related to my participation in ASA programs. I assume full responsibility in case of any accident or injury in connection with ASA’s programs and activities.
 
Use of Vehicles: I further acknowledge, with regard to any personal vehicle driven by me that in the event of an accident, there is no coverage afforded to me through ASA’s insurance policies for liability or physical damage sustained to any vehicle involved or liability incurred by me while operating my vehicle. I acknowledge that if I choose to park at any facility of ASA or Affiliated Organizations, I do so at my own risk.
 
No Reimbursement of Medical Expenses: I recognize and acknowledge there is no volunteer accident coverage nor is there any medical payments coverage available to me in order to compensate me for expenses I incur from deductibles, co-payments, prescription drugs, or medical services not covered through my own health insurance provider(s) for any injury the player sustains as a result of participation. I agree that any medical coverage(s) I have will be primary and under no circumstance will I seek any contribution from the ASA, or their insurer, for any medical expenses.
 
Informed Consent to Medical Treatment: In the event of an injury, I hereby give ASA full authority to take whatever action it feels is warranted under the circumstances regarding my health and safety, if I am not in a condition to give informed consent, including but not limited to the application of emergency medical procedures, the admittance to a hospital, or the care of a medical professional at my expense.
 
Photo Release: I also grant to ASA the right to take photography of me participating in ASA events. I authorize ASA to copyright, use and publish those photographs in print and/or electronically, but without my name.

By electronically checking this box you are agreeing to the above terms and conditions of this wavier. *
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